Before deciding on a Medicare plan, it’s a good idea to learn all you can about coverage options and costs.
The 6 questions below can help you narrow down your choices and find a plan that suits your health care needs and budget.
Who can help you choose the right Medicare plan? One place to start is talking to an adviser at an organization that meets NCOA’s Standards of Excellence.
Are you about to turn 65 and become Medicare-eligible? Before you choose a plan during your Initial Enrollment Period (IEP), it’s smart to learn all you can about the various coverage options and costs. After all, health care is one of the biggest expenses you’ll need to plan for in retirement.
What are good questions to ask about Medicare? Below are 6 things you should consider.
What are my Medicare coverage options?
Unlike traditional health plans, Medicare is made up of parts—and each part provides different types of coverage:
- Part A (Hospital Insurance): Medicare Part A generally covers inpatient care, including hospital stays, skilled nursing facility care, and nursing home care.
- Part B (Medical Insurance): Medicare Part B generally covers outpatient care, such as doctor visits and services, lab tests, ambulance services, and medical supplies and equipment. Together, Medicare Parts A and B are referred to as “Original Medicare.”
- Part C (Medicare Advantage): Medicare Advantage (MA) plans cover everything Part A and Part B cover, but they’re more comprehensive. These "all in one" plans may include additional coverage for prescriptions, vision care, hearing care, and dental care. Some even offer extra benefits to help you stay healthy, such as fitness center memberships and nutrition support.
- Part D (Drug Coverage): Prescription drug coverage is not included in Original Medicare. That's why many people choose to purchase a Part D plan to help subsidize the costs of the medications they need. Most MA plans have Part D coverage built in (these are called MAPD plans).
- Medigap (Medicare Supplement): A Medigap policy is a supplemental insurance policy sold by private insurers. It can be used with Parts A and B to fill any coverage gaps and help you pay for out-of-pocket (OOP) costs like deductibles, copayments, and coinsurance.
The right plan (or combination of plans) will depend on your current health and which services you think you’ll need in the coming year. For example, if you know you’ll require a root canal in the next few months, you may want to consider a Medicare plan that includes dental coverage.
Also, if you have health coverage through an employer or retirement plan, it's essential to ask how that plan will work with your Medicare coverage.
Will I have the flexibility to choose my doctors on Medicare?
Having doctors you trust is an important part of staying healthy as you age. With Medicare, your choice of health care providers depends on which plan you select. With Original Medicare, you can visit any doctor in the U.S. who accepts Medicare. If you have an MA plan, you’ll be required to stick to a specific network of primary providers, specialists, and hospitals.
If you’d like to continue seeing your current providers, check to see whether they accept Medicare or are included in the network of any Medicare Advantage plans you’re considering.
You should also think about how often you need to see specialists. While Original Medicare typically does not require a referral from a primary care provider to see a specialist, you may need one if you have an Medicare Advantage plan.
Will I have Medicare coverage while traveling?
Are you planning a retirement road trip—or a cruise around the world? Original Medicare covers hospital care and doctor visits in all 50 U.S. states and its territories. While some MA plans also provide state-to-state coverage, others may not cover services beyond a defined geographic area. Note: Both Original Medicare and MA plans are required to cover emergency and urgent care nationwide without restrictions.
Original Medicare does not cover services you receive while traveling outside the U.S., except in certain circumstances. Those same rules apply with Medicare Advantage plans, although some plans may offer extra benefits for international emergency and urgent care services. Certain Medigap policies pay for doctor or hospital visits that take place when you’re traveling overseas.
Will my prescriptions be covered under Medicare?
Each Medicare drug plan maintains its own list of drugs they cover (called a “formulary”). The formulary categorizes prescriptions by pricing tiers. The higher the tier, the higher your out-of-pocket cost.
Whether you’re considering buying a standalone Part D plan or getting your prescription drug coverage through a Medicare Advantage plan, it’s important to review the plan’s formulary to make sure it covers any medications you take. You’ll also want to find out which local pharmacies you can use to fill your prescriptions—and whether you have the option to receive medication by mail.
What will my out-of-pocket costs for Medicare look like?
“Many older adults are surprised to learn that Medicare does not cover 100% of health care expenses,” said Medicare expert Brandy Bauer, former Director of the MIPPA Resource Center. “Out-of-pocket costs—the costs you’re responsible for after Medicare pays its share—are a major factor to consider when choosing a plan. This is especially true if you’re living on a low or fixed income.”
Out-of-pocket costs apply to both Original Medicare and Medicare Advantage plans and include premiums, deductibles, coinsurance, and copayments. For example, the standard monthly premium for Part B in 2023 is at least $164.90/mo.
One major difference to note is that Original Medicare does not have an out-of-pocket maximum—meaning there’s no limit on what you might have to pay out of pocket for the year. For MA plans, the out-of-pocket maximum is $8,300, though some plans may set lower limits. Medicare Part D has catastrophic coverage that takes effect once you reach $7,400 in out-of-pocket costs for covered prescriptions.
When evaluating your Medicare plan options, be sure to calculate your expected out-of-pocket costs and limits to see if they fit into your budget. These specific questions can help you gain a clearer picture:
- What costs will I be responsible for on this plan?
- What is the plan’s annual maximum out-of-pocket cost?
- How much will I have to pay out of pocket before my coverage starts?
- What is the copayment for regular health care services I receive?
- Do higher copayments apply to home health care or hospital stays?
- What is the cost if I visit an out-of-network doctor or facility?
- What are the copayments for medications I take regularly?
If you have low income, you should also ask whether you qualify for the Medicare Savings Programs (MSPs). These Medicaid-run programs help cover Medicare premiums, deductibles, and other cost-sharing expenses. Qualifying for an MSP also makes you eligible for the Part D Low Income Subsidy (LIS/Extra Help). With an estimated annual value of $5,300, this benefit helps make prescription drugs more affordable.
Who can help me choose the right Medicare plan?
If you want to know, “How do I get unbiased Medicare advice?”, a great place to start is talking with an advisor from an organization that meets NCOA’s Standards of Excellence for Medicare Consumer Education and Insurance Brokerage Services.
At no cost to you, our partners will explain Medicare information in clear, easy-to-understand terms. You’ll receive impartial guidance, practical decision support, and trusted enrollment options—not a high-pressure sales pitch. Their goal is to help you find the right plan and feel confident in your decision.
Learn more about our partners that meet NCOA's Medicare Standards of Excellence and how they help older adults.